S-0670.2  _______________________________________________

                         SENATE BILL 5445

          _______________________________________________

State of Washington      56th Legislature     1999 Regular Session

By Senators Franklin, Winsley, Wojahn, Deccio, Thibaudeau, Kline, Rasmussen, Fairley, Patterson, Prentice, Kohl‑Welles, Costa, Eide and Spanel

Read first time 01/22/1999.  Referred to Committee on Health & Long‑Term Care.

Allowing the chair of a legislative committee to request review by the department of health of a mandated benefit bill.

    AN ACT Relating to a mandated benefit bill review process; amending RCW 48.47.010 and 48.47.030; adding a new section to chapter 48.47 RCW; and repealing RCW 48.47.020.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

    Sec. 1.  RCW 48.47.010 and 1997 c 412 s 2 are each amended to read as follows:

    Unless otherwise specifically provided, the definitions in this section apply throughout this chapter.

    (1) "Appropriate committees of the legislature" or "committees" means nonfiscal standing committees of the Washington state senate and house of representatives that have jurisdiction over statutes that regulate health carriers, health care facilities, health care providers, or health care services.

    (2) "Department" means the Washington state department of health.

    (3) "Health care facility" or "facility" means hospices licensed under chapter 70.127 RCW, hospitals licensed under chapter 70.41 RCW, rural health care facilities as defined in RCW 70.175.020, psychiatric hospitals licensed under chapter 71.12 RCW, nursing homes licensed under chapter 18.51 RCW, community mental health centers licensed under chapter 71.05 or 71.24 RCW, kidney disease treatment centers licensed under chapter 70.41 RCW, ambulatory diagnostic, treatment, or surgical facilities licensed under chapter 70.41 RCW, drug and alcohol treatment facilities licensed under chapter 70.96A RCW, and home health agencies licensed under chapter 70.127 RCW, and includes such facilities if owned and operated by a political subdivision or instrumentality of the state, and such other facilities as required by federal law and implementing regulations.

    (4) "Health care provider" or "provider" means:

    (a) A person regulated under Title 18 or chapter 70.127 RCW, to practice health or health-related services or otherwise practicing health care services in this state consistent with state law; or

    (b) An employee or agent of a person described in (a) of this subsection, acting in the course and scope of his or her employment.

    (5) "Health care service" or "service" means a service, drug, or medical equipment offered or provided by a health care facility and a health care provider relating to the prevention, cure, or treatment of illness, injury, or disease.

    (6) "Health carrier" or "carrier" means a disability insurer regulated under chapter 48.20 or 48.21 RCW, a health care service contractor as defined in RCW 48.44.010, a health maintenance organization as defined in RCW 48.46.020, plans operating under the state health care authority under chapter 41.05 RCW, the state health insurance pool operating under chapter 48.41 RCW, and insuring entities regulated in chapter 48.43 RCW.

    (7) "Mandated ((health benefit," "mandated benefit," or ")) benefit bill" means ((coverage or offering required by law to be provided by a health carrier to)) legislation that would, if it became law, require a health carrier to offer or provide coverage of:  (a) ((Cover)) A specific health care service or services; (b) ((cover)) the treatment of a specific condition or conditions; or (c) ((contract, pay, or reimburse)) specific categories of health care providers for specific services; however, it does not ((mean benefits established pursuant to)) include legislation that would only affect benefits available under chapter 74.09, 41.05, or 70.47 RCW, or scope of practice modifications pursuant to chapter 18.120 RCW.

NEW SECTION. Sec. 2.  A new section is added to chapter 48.47 RCW to read as follows:

    (1) Where the chair of an appropriate committee of the legislature determines it is in the public interest and consistent with the purposes of this chapter, the chair may request that any mandated benefit bill that has been referred to the committee be reviewed by the department under RCW 48.47.030.

    (2) In making the determination under subsection (1) of this section, the chair shall consider:

    (a) The extent to which the public has demonstrated an interest in the mandated benefit bill as evidenced by, among other things, testimony before or written submissions to the committee;

    (b) The extent to which there is uncertainty regarding the costs and benefits of the mandated benefit bill; and

    (c) The extent to which the review will yield new information that will assist the committee in evaluating the mandated benefit bill.

    (3) The request for review shall be in writing, and may indicate special concerns or interests the chair would like the department to address in performing the review.  Upon receipt of the request, the department shall respond to the chair in writing within thirty days, indicating one of the following:

    (a) That the bill is not a mandated benefit bill as defined in RCW 48.47.010 and therefore not appropriately reviewed under this chapter;

    (b) That insufficient funds were appropriated to the department for the purpose of reviewing the bill, and therefore the review cannot be completed; or

    (c) That the bill will be reviewed and the report will be submitted to the secretary of the senate and the chief clerk of the house of representatives at least thirty days prior to the start of the next regular legislative session.

    (4) A request for review or completion of the report by the department under this chapter is not a prerequisite to consideration and passage of a mandated benefit bill by the legislature.

    Sec. 3.  RCW 48.47.030 and 1997 c 412 s 4 are each amended to read as follows:

    (1) Based on the availability of relevant information, the department shall review a mandated benefit bill and report to the legislature regarding the following ((criteria shall be used to assess the impact of proposed mandated benefits)):

    (a) The social impact:  (i) To what extent is the benefit generally utilized by a significant portion of the population?  (ii) To what extent is the benefit already generally available?  (iii) If the benefit is not generally available, to what extent has its unavailability resulted in persons not receiving needed services?  (iv) If the benefit is not generally available, to what extent has its unavailability resulted in unreasonable financial hardship?  (v) What is the level of public demand for the benefit?  (vi) What is the level of interest of collective bargaining agents in negotiating privately for inclusion of this benefit in group contracts?

    (b) The financial impact:  (i) To what extent will the benefit increase or decrease the cost of treatment or service?  (ii) To what extent will the coverage increase the appropriate use of the benefit?  (iii) To what extent will the benefit be a substitute for a more expensive benefit?  (iv) To what extent will the benefit increase or decrease the administrative expenses of health carriers and the premium and administrative expenses of policyholders?  (v) What will be the impact of this benefit on the total cost of health care services and on premiums for health coverage?  (vi) What will be the impact of this benefit on costs for state-purchased health care?  (vii) What will be the impact of this benefit on affordability and access to coverage?

    (c) Evidence of health care service efficacy:

    (i) If a mandatory benefit of a specific service is sought, to what extent has there been conducted professionally accepted controlled trials demonstrating the health consequences of that service compared to no service or an alternative service?

    (ii) If a mandated benefit of a category of health care provider is sought, to what extent has there been conducted professionally accepted controlled trials demonstrating the health consequences achieved by the mandated benefit of this category of health care provider?

    (iii) To what extent will the mandated benefit enhance the general health status of the state residents?

    (2) ((The department shall consider the availability of relevant information in assessing the completeness of the proposal.

    (3))) The department may supplement these criteria to reflect new relevant information or additional significant issues.

    (((4))) (3) The department shall establish, where appropriate, ad hoc panels composed of related experts, and representatives of carriers, consumers, providers, and purchasers to assist in the proposal review process.  Ad hoc panel members shall serve without compensation.

    (((5))) (4) The health care authority shall evaluate the reasonableness and accuracy of cost estimates associated with the proposed mandated benefit ((that are provided to the department by the proposer or other interested parties,)) and shall provide comment to the department.  Interested parties may, in addition, submit data directly to the department.

NEW SECTION. Sec. 4.  RCW 48.47.020 and 1997 c 412 s 3, 1989 1st ex.s. c 9 s 221, 1987 c 150 s 79, & 1984 c 56 s 2 are each repealed.

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